Antiplatelet regimens for Asian patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis
- Authors
- Jung, Seung Jin; Shim, Sung-Ryul; Kim, Bum Joon; Jung, Jin-Man
- Issue Date
- 5월-2021
- Publisher
- AME PUBL CO
- Keywords
- Antiplatelet agents; Asian; network meta-analysis (NMA); secondary prevention; stroke
- Citation
- ANNALS OF TRANSLATIONAL MEDICINE, v.9, no.9
- Indexed
- SCIE
- Journal Title
- ANNALS OF TRANSLATIONAL MEDICINE
- Volume
- 9
- Number
- 9
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/137444
- DOI
- 10.21037/atm-20-7951
- ISSN
- 2305-5839
- Abstract
- Background: The optimal antiplatelet treatment for the secondary prevention of non-cardioembolic stroke or transient ischemic attack (TIA) remains uncertain in Asians. Methods: We searched for eligible randomized control trials in Medline, Embase, and the Cochrane Library. A Bayesian network meta-analysis (NMA) was performed to assess the efficacy and safety of antiplatelet regimens with placebo as the control. Each therapy was compared using relative risk ratios (RR) and 95% credible intervals (CrI), and ranked according to the value of the surface under the cumulative ranking curve. Results: A total of 84,103 patients from 32 studies were included: patients in used aspirin (n= 26,834); cilostazol (n=3,303); clopidogrel (n=12,406); prasugrel (n=1,885); sarpogrelate (n=752); ticagrelor (n=1,933); ticlopidine (n=1,644); triflusal (n=391); aspirin plus cilostazol (n=1,120), aspirin plus clopidogrel (n=4,623); aspirin plus dipyridamole (n=10,853); aspirin plus ticagrelor (n=5,859); aspirin plus ticlopidine (n= 132). Patients who used aspirin plus clopidogrel and cilostazol had a lower risk of recurrent stroke than those who used placebo. Patients administered with aspirin plus ticagrelor, aspirin plus clopidogrel, and cilostazol had a lower risk of composite vascular events than those administered placebo. Patients administered aspirin plus ticagrelor had a higher risk of major bleeding than those administered placebo. Clustered three-dimensional rank plots of recurrent stroke, major bleeding, and composite vascular events demonstrated that cilostazol had higher values of the surface under the cumulative ranking curve than other treatments. Conclusions: Of the antiplatelet regimens, cilostazol showed the best net clinical benefits than other antiplatelet regimens in Asians with non-cardioembolic stroke or TIA.
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Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
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